Individual
MS. MARISSA GRACE MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
1545 E. PYTHIAN ST., SPRINGFIELD, MO 65802
(417) 829-0800
Mailing address
1545 E. PYTHIAN ST., SPRINGFIELD, MO 65802
(417) 829-0800
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2023030573
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41305906
—
MO
Enumeration date
08/23/2023
Last updated
08/23/2023
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